Advice needed

[EMEddie]

Hello

i have been an RN for exactly a year. My first 9-10 months were spent in a medical icu step down where I learned a lot. A couple months ago I started a internship within the same hospital that provides theoretical/practical education in medical and cardiovascular icu. The program is 3 months and we got a month left.

I have learned a lot, I have done great in exams and the nurses I have worked with in both cvicu and micu have told our educator that I ask good questions and am doing good. He told me that I need to be more assertive and have more of an edge when interacting. What do you think he means more of an edge?

I communicate and interact well with the team members, but he says as an icu RN I need to have a stronger personality... This kind of bummed me out because I don't really know what to do/change on how he wants me to do.

do you guys have advice on how I can do/improve on this?

Thanks in advance.

[Angelrina,CCRN]

As long as you are able to communicate effectively with the team, you will be fine. Just be sure to put patients first and communicate pertinent information/status changes to the team.

[Been there,done that, ASN, RN]

Congrats on you internship, awesome opportunity.

I am thinking your instructor may be referring to your demeanor in class. Do you maybe come across as too soft-spoken?

Definitely ask him what assertive/strong personality means to HIM.

ICU nurses need to make sure the information was received and assuring the proper interventions are instituted STAT. It's another level of communication.

Let us know your instructors response, so we can explore this further.

[Biffbradford]

I think with more experience will come more confidence and that will be evident when you interact with others. In my CVICU orientation I was told that I concentrated too hard. Huh? Well, I can see how that might be construed but I certainly didn't want to screw something up!

[telemetryrn1]

It sounds like he is referring to your level of confidence and assertiveness. All nurses need to possess confidence and assertiveness in order to act and advocate for their patients and often without regard or concern for themselves, but it is even more important as an ICU or ER nurse as the expectations in these areas are demanding and high. You have probably heard the term "fake it till you make it" which may be what you will need to try. Even though you don't feel as confident on the inside, you must exude confidence outwardly, not only with physicians but with patients and family members. Most of what I describe comes with experience, however I have seen experienced timid nurses in ICU that still have a air of uncertainty even when they are knowledgeable and it is not good. They often fail to speak up or are afraid to approach physicians or others to advocate for what is needed for their patients. Some even when reporting symptoms end their phrase like it is a question, (inflecting their tone upward) which makes the physician less likely to take what they are saying seriously. You will earn the trust of your patient's, family members, colleagues, etc. when you can project yourself with confidence. Think about something you are an expert in (can be anything, ie., cooking, playing tennis) and think about how confident you feel when doing it or talking about it. That is how you need to project yourself as an ICU nurse

[aerorunner80, ADN, BSN, MSN, APRN]

I'm wondering if your preceptor(s) are looking for you to have more confidence when you are talking to the team.

That is going to be hard to develop because it sounds like you are being bounced around from unit to unit and every unit has it's own unique feel.

In the meantime, you can practice by having all of your ducks in a row by bringing the team all of the assessment information that you have when you have concerns. When I talk to someone, I will go to them and tell them first, I am concerned about XYZ. Then I back up my concern with my assessment information and past data that play into the situation. After that, I will ask for something specific such as an xray, labs, and for the provider to come to the bedside to assess.

As another poster noted, after you have been in your unit for some time, you can have everything ready to go before you go and ask for the order. I like the example they used such as having the dopamine strung up before you go ask for the order or sometimes if the pt has been on a pressor before and we still having it hanging, I will turn it on and then ask for the order to put it back on.

I wouldn't recommend just turning on a drip like that until you know your unit and what is OK and not.

It will come in time.